THE INFORMER

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  Summer 2004

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Below is an article on expressive writing to cope with trauma as appeared in the Winter 2006/07 issue of the Informer magazine submitted by Carl Rabstejnek

In 1986, James Pennebaker, along with another author, introduced a writing method for dealing with painful and harmful feelings. He showed that systematic Expressive Writing about negative life events could reduce the harmful effects resulting from untreated trauma.

The hurtful experiences considered were of recent nature and not childhood. For example, job loss, death of a spouse, recent sexual or physical abuse, entering college, relocation, divorce and serious illness were investigated. Unlike psychoanalysis, it is not necessary to deeply explore and

interpret early developmental experiences.

For two decades, Pennebaker researched and published on Expressive Writing. Other scholars have also followed-up. Pennebaker was author and coauthor of several articles. In that time, considerable empirical research by him and others has supported Expressive Writings effectiveness.

The writings need to deal with events that give rise to strong negative emotions. Positive emotions may yield different results. Similar groups of people, having experienced the same life event, evaluated at the same time, received no long-term benefits from writing about innocuous subjects.

Unlike talk therapy, which usually requires another person or persons, the Expressive Writing process can be done in private. It is not necessary to share your work with anybody else. Some later research also supports solitary speaking about negative events into a tape recorder.

Writing can be done on one’s own without a major financial investment. A pencil and paper will do.

It was shown that revelation, confession or A coming out@ is not necessary for the process to work. Substantial results are gained from writing in private and keeping the results to you.

At times, social support may enhance the process. However, sometimes disclosure is not helpful. The event and our social network must be evaluated by each of us before going public with our innermost thoughts and feelings.

A considerable number of research studies published during the decade (1987-1997) following Pennebaker’s initial presentation of the method, showed measured improvement from Expressive Writing. Several research reports have shown a reduction in visits to physicians after writing, compared to visits before writing. There were fewer visits two months (seven studies), six months (three studies) and 1.4 years (one study) after writing.

Ten studies recorded reductions in physiological signs. Signs are measurable bodily functions that may or may not be felt. Symptoms are what is sensed or observed.

Measurements included antibodies for Epstein-Barr and Hepatitis B viruses, heart rate and skin conductance, among others. A half-dozen behavioral studies showed increased grades, less absenteeism and greater re-employment. Half of 14 studies showed self-reported improvements in physical symptoms, depression, negative affect and distress. Seven of these studies failed to find effects from self-reports. Self-reports are perceptions and as such may not be a sensitive indicator of changes in the person. Most of the early research did not focus on underlying mechanisms but on demonstrating effectiveness.

Science requires that we not only demonstrate that things work but how they work. Although theory development is still in its early stage, some interesting ideas have been advanced.

An inhibition-disinhibition paradigm basically has inhibition leading to illness and disinhibition promoting health. Although there can be various feedback loops, we will consider a simple linear cause and effect form of the model. The negative sequence sees not writing (or talking) about a stressful event as inhibition, which in turn results in stress that leads to physiological and psychological problems. The corrective experience is based on disclosure that reduces inhibition, thereby reducing stress, followed by improved health.

Behaviorists consider writing and rewriting about the same stressor, time and time again, as a form of forced exposure. Repeated facing of a distressing situation gradually reduces its impact until it is eventually extinguished. Phobias, for example, are often treated by exposure methods. Research has shown greater A extinction@ by writing about the same event as compared to those who wrote about different events.

Cognitive exercises allow for the mental integration of emotional experiences into a person= s life story. Narrative study has shown that we create and live by a story that provides order, meaning and coherence to our life. When we meet unexpected or adverse events, we modify our own story to accommodate the new experiences. Assimilating new experiences is a way to cope and return a feeling of purpose to being alive. In other words, healthy living requires that we make sense of what happens to us by (re)organizing how we think about our experiences.

Improvement requires that we deal with issues and not ignore them. By controlled repetition of emotionally reactive events the sting subsides. This was explained above by behavioral means in promoting extinction. It can also be explained by modern cognitive-psychoanalytic means of A leaking@ of emotions from overwhelming events that are buried in the unconscious. This model holds that overwhelming events are buried until our conscious mind can deal with the material in small amounts. It implies acceptance of an unconscious, which is a controversial concept.

Cognitive psychologists emphasize the need to integrate disparate events into our sensible thought process. This approach does not require a belief in an unconscious mind, which bothers some people. There is some parallel dream work that considers writing similar to dreams; brain imaging during sleep shows the brain organizes storage of various life experiences. Thus, from various psychological perspectives the help received from Expressive Writing can be explained.

While the focus has been primarily empirical to date and theory is not fully developed, there is substantial evidence to recommend Expressive Writing. We will discuss a couple of the trauma types that have been researched and the results obtained.

Unemployment was a much studied area. Many times unemployed people do not share their feelings with others when they are out of work. Often there is a stigma felt about being laid off, even if it is part of major downsizing. Other events, such as death, divorce, and their associated feelings might be more easily talked about.

Baselines were established for both non-writers and a parallel group that wrote about their day= s plan. The control group was instructed to avoid discussing emotional material. The experimental group was told to delve into deep thoughts and feelings. In one study, all participants were unemployed and otherwise the same, except for the writing assignment. Those participating in Expressive Writing were consistently more successful in finding jobs over several months. Surprisingly, the job search effort between groups was the same. Each worked equally hard finding a job. The different results were attributed to some intangible item, such as attitude.

It might be helpful to identify some of the areas that unemployed people wrote about. Subjects covered were the problems and associated emotions involved with finding new employment; family and other relationship conflicts; concerns over finances; experience of the actual discharge; losses of relationships with others at work; feeling rejected; health concerns; and search assistance being received. Writers are encouraged to formulate their own theme and these ideas are just supplied to help you along.

Another complicated stressful life event has to do with bereavement when the loss of a loved one is by suicide. A comparison was made between writing groups. One of the groups was asked to focus on the events and emotions experienced in connection with the untimely death. The other group was to discuss their room layout and decorations factually, without reporting emotions. Over a two-week period they wrote four times. After six weeks the group that did Expressive Writing experienced less grief.

For this article to be useful, you will have to do the writing on your own. Reading this or attending an associated workshop is of no help if you do not do the work. The following guidelines describe the straightforward Expressive Writing process: